Most states across America increased the amount of their general fund dollars allocated to treat mental illness after slashing them during the height of the economic downturn.
The states were responding to last year’s deadly shooting in Newtown, Conn., where 26 children and adults were killed at Sandy Hook Elementary School by a young gunman who apparently had been suffering from significant mental health issues.
In Fiscal 2013, 37 U.S. states hiked spending to fight mental illness while eight states kept funding at steady levels and six states cut funding, according to a new report from the National Alliance on Mental Illness.
“Realizing the risks of failure to provide adequate public mental health services, governors and legislatures in many states began the process of restoring state mental health budgets,” NAMI says in the report. “Most states either increased or maintained state mental health authority budgets at current levels.”
The Good, The Bad and The Neutral
On the plus side, the group noted that Texas approved the largest mental health budget increase in the state’s history, voting to hike it by $259 million. On the negative side, North Carolina, Alaska, Wyoming, Nebraska, Louisiana, and Maine all cut spending in FY13. While on the neutral side, New York, Pennsylvania, West Virginia, Indiana, Alabama, Florida, New Mexico and North Dakota all kept their level of spending at the same rate as the previous year.
“Sweeping changes in public and private health care delivery systems and improving state economies provided opportunities in 2013 to strengthen public mental health services,” NAIMI said. “Reminded forcefully about the essential value of a robust mental health service system, lawmakers in many states began to replenish resources that had been lost during the recession. Despite these advances, public mental health systems remain woefully underfunded.”
Federal Government Action
On the federal front, NAMI said that under the Affordable Care Act, monetary subsidies will be provided to estimated 2.65 million people to let them buy private health insurance on the new marketplace exchanges. Private health insurance covers about 27% of mental health services in the U.S., the report says. And unlike Medicaid, private health insurance reimburses inpatient psychiatric care for non-elderly adult beneficiaries and covers a wider selection of prescription medications.
Meanwhile, the Supreme Court decision that upheld the ACA did not require states to expand Medicaid coverage to more people. This left it up to the states as to whether to expand the program. So far, 25 states and the District of Columbia have expanded it while 22 have not with three still debating its merits.
“Medicaid is the most important public health program for mental health service delivery, currently financing 27% of all mental health services,” NAMI says. “Expanding Medicaid to 138% of poverty, as allowed under the ACA, is the best strategy available to strengthen the mental health system.”
Personnel Matters
But this increase in funding may be coming at a difficult time for personnel in the healthcare industry.
According to a new report from the Center for Excellence and University of Illinois at Chicago, local health departments in the United States are having problems in attracting and keeping skilled workers as they face increasing demands for services combined with decreasing financial resources.
The study cited U.S. Labor Department data showing that from 2004 to 2010 the number of psychiatrists declined by 9.4% while mental health counselors fell by 10.1%.
Recommendations for 2014
NAMI released its recommendations for state priorities in 2014: Actively engage in outreach and enrollment; comply with mental health parity; expand Medicaid; increase integrated care; increase the mental health workforce capacity; identify mental illness and intervene early; build the bridge from Medicaid to private health coverage; increase access to supported employment services; increase housing with supportive services; increase justice system diversion strategies ; and increase housing with supportive services.
“Dramatic changes in American healthcare finance and delivery systems combine with an improving economy and a growing array of best practices to provide a window of opportunity in the next few years to transform the mental health system and integrate care across systems," Naimi says. "Advocates and policy makers should continue the work of building the mental health system of the future, one in which mental illness is identified as it emerges and an array of proven, cost-effective services are available as needed to provide children, youthand adults with the mental healthcare they need to stabilize, recover and live healthy lives.”
